Provider Demographics
NPI:1922575901
Name:YALE MAIN STREET DENTISTRY, PLLC
Entity Type:Organization
Organization Name:YALE MAIN STREET DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARROTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-875-7269
Mailing Address - Street 1:6962 LAKEPORT DR
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-2209
Mailing Address - Country:US
Mailing Address - Phone:810-545-8215
Mailing Address - Fax:
Practice Address - Street 1:210 S MAIN ST
Practice Address - Street 2:
Practice Address - City:YALE
Practice Address - State:MI
Practice Address - Zip Code:48097-3319
Practice Address - Country:US
Practice Address - Phone:810-387-4746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental